The Denial Mitigation Lead will assist the Denial Mitigation Supervisor and/or Manager in daily operations and work flow of the Denial Mitigation Department leading the work Financial Counselors, Authorization/Appeal Specialists, Denial Specialists and Denial Analyst to ensure that financial applications, authorizations, appeals, and/or correspondence are processed in a timely manner in accordance with BMHCC and/or the payer’s policies and procedures.
This work encompasses all oncology infusion, radiation oncology clinics across multiple clinical oncology sites, and/or all BMHCC hospitals. The Lead will assist the Supervisor and/or Manager in collaboration with the overall clinical oncology and/or hospital departments, physicians and hospital revenue cycle departments to ensure that the staff meet the metrics, mission, vision, and values of the BMHCC organizations.
Assist Supervisor/Manager in overseeing work assignments of staff responsible for financial applications, authorization, appeals, correspondence for oncology services and/or hospital services across BMHCC. Assist in providing educational tools and continued education for the team as it relates to oncology drugs and/or outpatient services to meet medical necessity guidelines and obtain authorizations/appeals. Assist Supervisor/Manager with preparing information for staff meetings to keep staff informed of payer updates, workflow changes, and other information as appropriate.
Responsible for monitoring all assigned workqueues to ensure all timelines are met to obtain authorizations, file appeals, complete triage reviews and retros, and/or complete timely write-offs and reporting insufficiencies to the Supervisor/Manager. Coordinate with internal and external customers to assist Supervisor/Manager with identifying opportunities for improvement. Responsible for reporting any system issues, payer issues, or anything that impacts the department work, present suggestions for resolutions to supervisor/manager, and assist in implementing any changes.
Thorough knowledge of payer specific guidelines as it relates to oncology drugs and/or outpatient services and assist Supervisor/Manager in portal education of other team members. Contributes to a positive work climate and the overall team effort of the department. Conduct site visits for education of staff as needed for new hires and re-education.
Ensures that customer satisfaction is achieved through courteous and effective communication, problem solving, and efficient processes. Maintains confidentiality in compliance with HIPPA regulations and ensures that department remains compliant with all relevant regulations. Works with internal and external customers to identify opportunities for improvement, which result in enhanced denial management services and customer satisfaction.
Collaborates with Clinic Directors, as applicable and coordinates meetings/site visits as needed to develop workflows and address issues as they arise and provide direction on next steps. Research and collaborates with the Director Denial Mitigation in the resolution of treatment and services denied by Medicare, Medicaid, Tricare, commercial payers, and Managed Care organizations. Performs other duties as assigned and directed.
Experience Minimum Required 3-5 years of business experience in a healthcare environment with 3 of those years working in a hospital, physician office, revenue cycle, denial management, patient accounting, or payer environment performing activities such as correspondence processing, denials, appeals, billing, collections, registration, scheduling, medical record requests, payer follow-up, or administrative support. Preferred/Desired 5-7 years of business experience in a healthcare revenue cycle with at least 5 years in authorization, denials, billing correspondence and/or appeals within a multi-hospital system; prior team lead, senior representative, trainer, or workflow coordination experience preferred.
Experience training staff, developing standard work, monitoring team performance, conducting quality review, or supporting process improvement initiatives preferred. Education Minimum Required High school diploma or equivalent required. Associate or Bachelor’s degree in related field or 4 years’ experience in the healthcare specific area.
Computer literacy and medical terminology knowledge required. Preferred/Desired Associate or Bachelor’s degree in related field preferred. RHIT, LPN, CRCR, or other healthcare revenue cycle-related credential preferred.
Training Minimum Required Ability to communicate clearly and effectively using standard English in written, oral, and verbal formats. Must be able to document information accurately, provide clear direction to team members, and communicate professionally with internal departments, leadership, and payer contacts as needed. Strong organizational, analytical, problem-solving, and workflow management skills with the ability to understand and troubleshoot interconnected correspondence, denial, payer, and revenue cycle processes.
Preferred/Desired Strong organizational, analytical, problem-solving, and workflow management skills with the ability to understand and troubleshoot interconnected correspondence, denial, payer, and revenue cycle processes. Special Skills Minimum Required Working knowledge of Microsoft Office products, including Excel, Outlook, and Word. Comfort with data entry, work queue management, document management, revenue cycle software, patient management systems, payer portals, and Windows-based applications required.
Familiarity with electronic medical records, patient accounting systems, claims or practice management systems, payer portals, correspondence workflows, and denial mitigation processes. Preferred/Desired Advanced proficiency in Microsoft Excel, including filtering, sorting, grouping, pivot tables, data validation, and tracking tools. Experience creating reports, monitoring productivity, analyzing correspondence trends, and supporting workflow dashboards preferred.